No question, hands down, I get more requests from friends, family, and acquaintances for help finding support and and advice parenting anxious children than any other pediatric issue in the school years. So it’s my sincere DELIGHT to introduce and partner with Dr. Kathy Melman on my podcast. Dr Melman runs the outpatient psychiatry and behavioral health clinic and has decades of experience advising families and supporting anxious children. She helps translate the facts around what causes anxiety, how to discern anxious behavior from clinical anxiety, and helps parents understand just what we know and what we don’t. Her tips and advice below!

Where Does Anxiety Come From?

1. Anxiety is a normal emotion and a natural part of life. Fear exists in all of us and there are typical fears that are seen at different developmental stages such as Stranger Anxiety (clinging and crying) at 7-9 months of age. This happens as the child goes through developmental changes such as the stronger ability to differentiate familiar faces from those that are unfamiliar. Anxiety is a normal and important emotion that is adaptive and protective. For example, anxiety helps us stay away from dangerous situations such as leaving or not entering a building when we see smoke or fire or smell something burning. Imagine living at a time or in a place without grocery stores or restaurants for securing food, without homes with locking windows and doors. Imagine that we instead have to venture out to hunt and gather food with concern about dangerous animals or people lurking behind a bush. In this situation, concern about safety is warranted and being vigilant, scanning the environment to pick up on danger cues would help someone survive. The rush of adrenaline that occurs when highly anxious is called the “fight or flight” response and it helps someone escape or avoid dangerous situations.

2. Environmental Stress: Anxiety increases in more stressful situations. This can includes fear of safety, homelessness, instability with frequent moves or other important life changes, loss or death of caregivers or other important people, war, hearing or seeing disturbing news, economic difficulties, abuse, sexual assault, bullying at school, high pressure, expectations and demands in school, home and/or activities. Even in healthy, safe environments, all children experience some anxiety. For example, occasional or short lived worries occur when a child is faced with an especially stressful or new, unfamiliar situation. These are real issues with all that is going on in the world right now.

3. Environmental Learning: Dr. Melman reminds, “Children Learn What Children Live.” Modeling matters. Listen to what Dr. Melman shares in the podcast about overprotection and the risks of being over-involved.

4. Avoidance. Anxiety is maintained and strengthened by avoidance. Through avoidance, you don’t get to see that your worst fears will not happen and that you can, in fact, do it! Let’s look at an example of a child invited for a sleepover at a friend’s house. Perhaps this child is not experienced with sleeping away from home and struggles with sleeping in his own room and bed at home. The idea of a sleepover sounds fun and then reality hits as the time to go to sleep approaches. The child becomes panicked, maybe with physical symptoms such as heart racing and pounding and stomach aches. He has thoughts that he won’t be able to fall asleep or that something bad will happen like a robber breaking in, and calls his parents to pick him up which they do. The child starts to feel relieved and no longer anxious as soon as they learn that they can escape this feared situation by going home. The child’s fear and desire to escape and avoid is strengthened because of the strong relief is experienced when rescued and by the fact that parents agreed that there was a need to come home rather than an ability to cope, ride out this wave of distress, stay the night and see that nothing bad happened and that he could, in fact, be courageous!

5. Expecting Bad Things to Happen: Anxious thinking also plays a role in where anxiety comes from.

6. Genes: Anxiety Disorders runs in families. What can we do if our child has a genetic loading for anxiety disorders? While we can’t change genes, we can aim to reduce stress in our lives and change our own modeling and reactions. We can learn to understand and accept our child’s temperament/wiring and empathize with our child’s feelings while also teaching our children how to think more realistically about the world, to expect less danger in situations, and encourage our child to approach in a gradual and consistent manner the situations that he or she fears. We can give our children skills to cope more effectively with challenging situations.

Over the weekend I took a trapeze lesson. Like a real one — one where in a matter of minutes an instructor quickly details how to get the safety harness on, how to jump up to the bar, throw your legs over, arch your back and fly through the air. The goal is to learn (rapidly) how to accustom yourself not only to the environment and to the sport but to let go of the bar, fly through the air, and catch a partner’s arms who is simultaneously swinging on another trapeze. All this WAY up in the air.

Within a few moments of some ground instruction we were escalating into the air up a ladder some I don’t know, 20 to 30 to 40 feet in the air. You lose perspective of distance the faster your heart beats. The instructions came quickly, the rapid-fired commands kept thinking to a minimum while also maintaining transitions with necessary momentum. For the first time in a long time I was really doing something I’d never done before. I’d never met these instructors, I’d never been to this place, and I’d not swung upside down by my knees since middle school. At the same time that I was asking my mind to override a great fear of heights I was demanding that my body acquire a new set of muscle memories and choreography. It was oddly taxing. Because of that, I suppose, it was also wildly rewarding when I was successful. There truly was a moment when I thought I may not climb the ladder.

We ask our children to do this constantly. I mean…..constantly. We drag them to new places, we meet new people, we ask them to rapidly acquire new coordinations, new social situations, new goals. And all the while we expect them to do so without much anxiety, without much complaining, without much of a margin for TERROR. This is childhood, this constantly newness, and I would like to say today I think we’re out of touch.

Exhibit A: Over the very same weekend where I trapeze-d through the air I piled my boys into the car Saturday morning after I mentioned we’d drive to a new place, meet with a new man who would instruct them in a music lesson both on a known instrument and a on a new one. I didn’t think it would be such a challenge. But when I heard the instructor quickly explaining what it meant to transpose from the key of C to G and my the neurons in my own mind went into a pretzel I wondered just why the little dudes weren’t curling up on the floor saying, “there’s no way I can learn this so fast.”

Sunday we did things we’d done before.

But then WHAMMMO, on Monday morning, less than 48 hours after Exhibit A, we drove to another place my boys had never been, we walked into a room full of complete strangers (we truly didn’t know a soul), and I left my two boys to this group within about 10 minutes. This was just a summer camp they’d never tried before: Exhibit B. But if we zoom out to a fair perspective it was also a foreign country of experience a vast ocean away (new camp, new people, new place, new skill requirement).

I walked to the car, tears welling up in my eyes, after seeing the look on my 7 year-old’s face as I left the room. It perhaps perfectly captured his reality. It was something like this:

I’m terrified, Mom, to stay here and do this but I believe you that it will be fun and I believe I am capable and I believe over-riding the terror I feel will lend itself to something good. I know I will reap the colorful reward of accomplishment, connection, new friends, and fun. But I’m scared and I am asking a lot of myself every single time I do this

And the trapeze reminded me. We ask our sweet babies to learn and reach and stretch and grow and start things new constantly. Think of a new school year. This post just a reminder, after a quick lesson at 30 feet, we have to remember the herculean tasks we expect and the patience we can have for nurturing tremendous grit but also the compassion we must also embody as we acknowledge the enormity of the challenge in doing something new.

I haven’t felt like a pro in knowing how to talk about sex with my boys. No matter that I was a middle school science teacher, I’m now a pediatrician and an ever-evolving mom of two. It’s a tough topic even for me as a “talker.” So it was a TRUE JOY and huge relief (let’s be honest) to podcast with two international pros in talking-to-girls-and-boys-in-building-up-esteem-and-confidence-and-knowledge around puberty and sex…

This past month I spoke with Great Conversations co-founders, Julie Metzger and Dr. Rob Lehman. They share their profound expertise and compassion in talking to boys and girls about sex and sexuality and supporting children growing into adults. We broke these podcasts up by age — what to say to a 9-year-old versus what to say to 12 year-olds and what we can say to our teens. I learned so very much from these courageous, kind, and amazingly brave experts — about our connection to the success for our children — and how we meet soul-to-soul with our children in conversations as they traverse life and sex and growing up.

4 Quick Tips For Talking About Sex With Boys and Girls:

Here’s a few takeaways but really, it’s better if you listen to Julie and Rob explain in the podcasts. Really.

“Don’t over speak!” advises Julie Metzger. It only takes 1 minute of courage! Our kids and teens don’t want long-winded, hour-long conversations when questions come up. Keep it short and simple and don’t freak out. Julie teaches girls to plant questions when there isn’t even time for a big response so we adults can get ourselves together to respond. And she reminds: swift, authentic answers when children ask questions are likely best. Phew… one minute of courage. I can do that.

Happenstance helps: Some of the best conversations happen because of what is happening in the world (dogs mating, Janet Jackson’s top falling off, buying tampons and children asking about it). And this is a series of a bazillion conversations throughout a child’s lifetime, not one BIG SEX TALK. Let the nuance and randomness of life support your conversations over time about sex, sexuality, their bodies, and their opportunities.

Everybody wants this to go so well: So many people want puberty and “the sex talk” to go well but even more so, everybody wants a child to do well in their teen years as they grow up. These children are literally flanked by those who want the best for them. From teachers, to parents, to coaches and pediatricians, relatives and neighbors. You have a network of people who want to help and support your child/teen through this time period — remind your teen.

Lead with the positives and avoid conversations that involve “don’t.” You can express your values without closing doors. Opening lines for sharing your beliefs without shutting things down for your child: “What we hope for you is……” or “in our family we believe….” And the other thing — if and when the puberty talk comes up or the sex talk floats in the air, talk about the great things in puberty first (getting taller, gaining independence, more feelings of love and crushes and lust for others) before delving into the tough stuff that may seem a bit unsavory.

A couple of weeks ago I read a piece entitled, “The Right Way to Bribe Your Kids to Read.” I was raised by two parents that scoffed at the idea of paying for grades and certainly never used money as incentive for habits and behaviors that were “good” for me. So I suppose like all of us, I am a product of parental molding, and therefore lean into that belief. So when I opened up the article in my hands it was with skepticism. Sure, it turns out, lots of you believe in using allowance or money, even in tiny allotments, as reward for the lovely habit of learning to love to read. That extrinsic motivation isn’t wrong — and there’s a bit to it, incentive-wise. The article reviews how it can work and how it certainly does for some families with somewhat hesitant, young readers. And although it didn’t convert me into pushing quarters around the house to urge the boys, the article really has changed the last week and a half around here.

Not all babies come out great sleepers and not all babies come out eager readers. That being said, even those of us who don’t come out that way sometimes learn to love it (I’m exhibit A). We really should read to our babies the day they are born.

I’ve got one boy in my house who can’t get out of the books. Wormy and delicious, he’s constantly distracted by the stories of the pages. Two days ago he’d announced he was saving the new Harry Potter book for a ferry ride we have coming up and then last night, sitting on our front steps, he whispered to me, almost as an admission, that he’d finished it. Just couldn’t not open it up…

The other little boy around here is a lot more like I was. He’s drawn to the vivid emotion of human interactions; he’s buoyant and wild. In his loudness with life he gets jet fuel energy from playing with people and their ideas, humor, and emotion. He feeds off reciprocity. The characters and stories and prose of books haven’t yet snagged him in a way that he reaches for those characters like he reaches for his brother or for me in the morning. He loves to see how his emotions change ours. And the characters and ideas in his books haven’t yet started talking to him.

So the article about bribing and reading together got me thinking I could help. And a little voice rumbled around in me after reading it urging, “Wendy Sue, no matter how ‘busy,’ it can’t just be books at bedtime, you have to sit together and read at all times of the day.”

So for the last week and a half we’ve been reading together at unusual times. Snuggling up on my bed after getting home from work, on the couch with the coffee, in the corner of the room reading together or outside as the sun creeps up. Ten minutes here, 20 minutes there. Sometimes my little extrovert reader reads out loud to me or sometimes we each read our own. And this bounty with him came from realizing, of course, that I could show him that someone just as desperate for the people I love to share my moments and experiences, my laughter and hopes for the world can also find a bit of salvation in story and poetry. That over time I could live out the truths in front of him that there is safety and solace, intrigue and escape, hope and helium-heart courage, and essential camaraderie in these books. We can stumble upon an even bigger sense of self from words in a book. And sometimes it can take our breath away.

Like today. This morning as we sat together as the morning unfolded and the minutes poured out, I fell in love with a poem I’d never read before. Fell in love with the words so much that I ran my fingers over them after I found them. And I especially danced around in a few lines of it.

Even this middle-aged extrovert is finding newness in words in the morning. Thanks to my little 7 year-old reading partner.

It’s a hot and dusty world. Glimmering , and dangerous. ~Mary Oliver in Prose Poem: Are You Okay?

Yes, it certainly is. Thank goodness we have each other and thank goodness we have the prose of these books and these writers. Thankful for this new habit of togetherness with words with my little reader. Hopeful and knowing you’re also finding similar pockets of stillness this generous summer, too.

EVERY new parent worries about their newborn from how much they are eating, sleeping, peeing and pooping to ensuring they hit developmental milestones. We also worry about how they breathe and how they sound. It’s a stressful time period and most aren’t running on tons of sleep themselves — so we’re more emotional baseline. Occasionally, a terrifying thing happens where your infant turns bright red, or even blue or pauses their breathing. They may arch in a funny way or get stiff in their arms or legs. We may wonder if something serious is going on. If your infant (under 12 months of age) has an episode where they have pauses in breathing for less than 1 minute, they turn blue and then recover to normal…chances are…it’s normal. Normal? Turning pale or blue doesn’t seem normal nor does having your baby get stiff, nor does a second where they pause their breathing, but it can be, and there’s a name for it: Brief Resolved Unexplained Event (BRUE).

No question we have to trust our instincts if we think something isn’t going well for our babies and I always suggest seeing your pediatrician or family physician or nurse practitioner if you worry about your infant’s health, for reassurance. No question! Go in, get reassurance and learn. Don’t ever feel bad if everything checks out — this is why your pediatric team is there for you and your family. However, when you do go in for an evaluation from a nurse practitioner or physician, even if your baby has unusual breathing at times, or tenses, or even has a change in color, you may not need a lot of testing. Sometimes it’s normal.

Some Information About Breathing Patterns In Infants:

Periodic Breathing: Newborns breath less regularly than older infants, children or adults. This is in part because of their immature brain stem (the part our brain that regulates the drive to breathe). The majority of newborns experience some periodic breathing in first couple weeks of life and most infants don’t have periodic breathing after 4 or 5 months of age. The term “periodic breathing” captures behaviors where babies breathe rapidly for a few moments, then pause for a few, then breath rapidly again. Most of the time periodic breathing happens with pauses that last no more than 10 seconds. It can appear really unusual to a new parent or relative. The Academy of Pediatrics defines it this way: “Breathing is often irregular and may stop for 5 to 10 seconds—a condition called normal periodic breathing of infancy—then start again with a burst of rapid breathing at the rate of 50 to 60 breaths a minute for 10 to 15 seconds, followed by regular breathing until the cycle repeats itself. The baby’s skin color does not change with the pauses in breathing and there is no cause for concern.”

Color Change: babies can change color with crying, eating, fatigue or movement. Most of the time parents notice that babies will get bright red or ruddy while other times parents worry their baby looks pale or even a bit blue. It’s true that color change can represent underlying heart or breathing problems so if ever sustained over 1-minute it needs to be evaluated promptly. However, color change in infants over 2 months of age that resolves within 1 minutes may not need any work-up after you check in with a clinician. Sometimes color change can come from things like gastroesophageal reflux, coughing or choking, too. If any concern about your baby’s color it’s worth checking in with the pediatrician for a physical exam. While in the office, a pediatrician will do a full physical exam and ask lots of questions, and they can also check a spot oximetry for oxygen levels (pulse oximetry is standardly obtained in first 24 hours after birth to check blood oxygen levels to screen for underlying heart problems), do a electrocardiogram (EKG), and have observation.

Noises: babies make all sorts of terrifying sounds! Gagging sounds, choking, gurgling, sneezing, and coughing. Most of these during infancy fall in the range of typical and normal if they don’t interfere with eating, breathing, and sleep. Sneezing is fairly common in the first couple months, again because of immaturity of reflexes. Some parents worry about babies who spit up and sound like they can’t breathe and want to put babies on their tummies. No evidence that is recommended and to lower risk of SIDS, we always recommend babies are put on their back in bare crib for sleep.

Summer is upon us and we all want to do our best to keep our families safe and healthy. Some of the summer reminders can seem obvious. You’ve likely even heard the reports out last week warning against using a blanket to shade a baby in a stroller (those enclosed spaces can heat up like greenhouses). Heat waves, sun, vacation, time away from routine, summer is a time of typical increasing adventure and exploration. The product of exploration are bumps and bruises and scrapes and sometimes, even burns. Quick reminders here for why to use effective prevention medicines and how. Pretty obvious advice, but here’s 3 items you should have readily available all the time: sunscreen, insect repellent and maybe even antibiotic ointment — although bandages are a start. You can reach for the ointment once you get home!

1. Protecting Children From The Sun

Use broad spectrum sunscreen that covers UVA and UVB rays with an SPF over 30. As a reminder UVA are rays that cause aging to the skin and UVB rays cause burns. Both are bad news, especially during childhood.

Sunscreen isn’t the BEST protector for our skin– shade is. But being outdoors in the sunshine is the essesnce of childhood. Consider sun protective clothing like rash guards, hats and sunglasses – always better to use things that can’t be absorbed in the skin! And plan activities in direct sun to avoid the most intense sunshine of the day (between 10am and 4pm) when you can.

Choose an SPF over 30 (SPF refers to the amount of protection the sunscreen provides against UVB rays), anything over that doesn’t make much difference. More than what kind of sunscreen is how you use it. Apply 20 minutes prior to sun and every 1-2 hours while in the water or high activity.

Look for sunscreens that include zinc or titanium and avobenzone — these are physical barriers rather than chemical ones — that are less likely to be absorbed in the skin.

2. Preventing Insect Bites

Summer brings out bugs including mosquitoes, wasps and flies. No question we’ve all been thinking more about mosquitoes than ever before with Zika in the news. Here’s a clear and easy-to-read resource on what repellents to use if you live in an area with Zika transmission.

Children should wear long-sleeved shirts and long pants if in areas with lots of insects as that will help protect from bites more than anything else. On areas exposed outside the clothes, you can use repellent.

Use Environmental Protection Agency repellents. All EPA-registered insect repellents are evaluated for safety and effectiveness.Reapply insect repellent every few hours as directed on the bottle

Do not spray repellent on the skin under clothing and don’t use products that are a sunscreen and insect repellent mixed together — dosing intervals are different and areas they are needed often are, too. If you need both products, apply sunscreen first and then insect repellent over it.

It is safe to use EPA–registered insect repellents if pregnant and/or nursing!

This is a podcast episode about one thing…the penis. Guest on the podcast Dr. Rob Lehman, the co-founder of Great Conversations and leader of the For Boys Only classes at Seattle Children’s hospital joins me to discuss what’s “normal” and all the examples of “normal but different.” We dive into what parents need to know about care of uncircumcised/circumcised penis, thoughts on erections (they begin in utero!), boys with their hands down their pants, appropriate touching and ways to help boys deal with a culture focus on size. I often say that when I’m in clinic, I get the most attention from parents when I’m talking to them about their child’s genitals and many families are nervous to ask about concerns. It’s something everyone wants to know about, but a lot of people are shy or embarrassed to bring it up — do hope this podcast helps. Don’t hesitate to ask concerns you have from the very beginning — most often you’ll likely get A LOT of reassurance.

I am a mom to two boys and like every other mom I know was surprised from the beginning with the amount of “hands down the pants” moments that start even in infancy. A treat to have Dr. Lehman provides great tips to normalize and set appropriate boundaries for touching and clear up ideas for better understandings of normal development.

We do have to pick our battles at home. As a pediatrician I’ve never gotten too excited about advising parents to spend a lot of energy trying to rid your child of the thumb-sucking or nail biting habit. In general parents aren’t successful — peers are. Often it’s when friends or peers bring the habits up that children are motivated to stop. We can help support them by reminding them when hands are in their mouth or even having them place socks on their hands while watching television as that’s a common time for the behavior. Although many parents worry about their children sucking their thumbs and fingers, it’s a common habit, with some studies finding almost 25% of children do. Much time is spent thinking about ways to help our children quit, worrying whether germs on their hands will translate to illness and hoping it doesn’t affect their teeth. A new study today this week in Pediatricshighlights perhaps a positive effect of thumb sucking. It’s worth a mention.

Allergy Protection From Thumb-Sucking And Nail-Biting?

The study evaluated children between age 5 and 11 and their later diagnoses of hay fever, allergy skin prick testing and asthma. The premise of the study builds off the somewhat controversial concept of the hygiene hypothesis. The basic premise of the hypothesis is that germ exposure early in life can contribute to how our immune system responds as we grow and develop. We may build up tolerances and immunity that conform us into less allergic people if we have different bacteria and germs around. Basically, living in a sterile environment may not be “safer” as some believe lots of dirt, bacteria, and germs early and maybe not so many sensitivities later…

In the past theories for the hygiene hypothesis have supported a decrease risk of asthma (dirt and germs coming in from and on pets may decrease allergies or asthma later) and a small 2013 study a couple years back found those children who had parents who “cleaned” the pacifier with their own mouth may be less likely to develop allergies (theory was the bacteria transfer from mom/dad’s spit to baby changed their pattern of exposure to bacteria and possibly a tendency away from allergies and asthma later). So some researchers looked a the effects of children who have their hands in their mouths more to see if any protection comes of it — they evaluated data spanning from childhood to adulthood. Read full post »

This post is written in partnership with a Seattle Children’s parent, Beverly Emerson, who wanted to give back to our efforts. She’s a mom, food marketing, and R& D executive who has been thinking about how to get healthy food choices out to children for over 2 decades.

My two boys eat veggies pretty well. But that’s like saying Tuesdays are always good days. Sometimes it’s easy, sometimes it isn’t, of course because I’m raising humans on the planet and every day is something a little new. I think the reminders from Beverly may trigger some change in us. Beverly answers this:

“How can I get my child to eat two cups of vegetables a day?”

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

According to government recommendations, our kids need between 1 and 3 cups per day depending on their age. Does it feel like that is a dream? Like one of those stretch-goals that will never be hit? There are some tricks to make it easier, and none of them involve hiding vegetables, but actually encourage kids to embrace the fresh flavors and textures of vegetables in their natural state. Yes, it really is possible!

Here are three keys in getting kids to eat (and LIKE) their vegetables:

1. Start Early & Keep Going

Research shows that if a pregnant woman eats vegetables regularly in pregnancy, her infant will be more accepting of the flavors as well during the transition from milk-based diet to introduction of complementary foods. But acceptance begins to decrease as kids move into toddlerhood and preschool years. Humans are biologically wired to dislike bitter foods, and so we need to work at continuously exposing our children to the flavors. Susan B. Roberts, a Tufts University nutritionist and co-author of the book “Feeding Your Child for Lifelong Health,” suggests putting a food on the table at least 15 times to see if a child will accept it. At our house, we use a “thank you bite” model. We insist that our children have one tiny “thank you” bite of a new food simply to expose them. I know that she won’t like it the first time, and maybe not the fifth time. But suddenly, she’s reaching for a full helping! Until that happens, you can prepare dishes that YOU will eat so you don’t feel like you’re wasting food. Read full post »

Recent heartbreaking news reported about a baby who died due to a medication overdose by his babysitter/nanny has me reeling. And although this is a tragic, outlier type event, it can awaken us to everyday ways to improve our children’s safety with over-the-counter medicines.

The tragic story: a fussy baby was mistakenly given allergy medicine to calm him down and get him to sleep after a day of crankiness. Allegedly, the babysitter unfortunately gave an adult dose of an allergy medication. Sometimes medicine side effects can impair or stop breathing. Especially at elevated doses. The lesson from this horrific story is threefold:

Medicines, even those sold over-the-counter have real effects and demand our serious attention. We need to make sure medication dose is the right one. The story of this tragedy is a nightmare to even think on, but it can remind us to make sure we are always a part of every dose our children are given of ANYTHING. Every parent should know it’s not “over-the-top” to have any caregiver review medication administration with you every time for safety.

Kid medicines for kids not for the adults who care for them. Medicines should be used only when necessary and not for adult convenience. Fussiness in babies is exhausting for parents and caregivers. Read about fussiness and the period of PURPLE crying here especially in early infancy that’s considered normal. We need familial and community support for parents exhausted and overwhelmed by fussy babies. And we need back-up plans for respite for caregivers to babies, but we also need to remember that medicines given to a child for the benefit of a parent just isn’t the reason they were designed or licensed. As a pediatrician I just can’t recommend using allergy medicine to knock your kid out. Just doesn’t make sense. Proper and appropriate medication dosing is paramount but using medicines only when necessary is where you have to begin.

Allergy medicines, even over-the-counter medicines are not recommended for use in babies under age 2 years.

What’s New

About This Site

Seattle Children’s provides healthcare for the special needs of children regardless of race, color, creed, national origin, religion, sex (gender), sexual orientation or disability. Financial assistance for medically necessary services is based on family income and hospital resources and is provided to children under age 21 whose primary residence is in Washington, Alaska, Montana or Idaho.